Nutritional Support in Head and Neck Radiotherapy Patients Considering HPV Status.

Adam Brewczyński,Sławomir Mrowiec,Tomasz Rutkowski,Beata Jabłońska,Krzysztof Składowski

doi:10.3390/nu13010057

Abstract

Malnutrition is a common problem in patients with head and neck cancer (HNC), including oropharyngeal cancer (OPC). It is caused by insufficient food intake due to dysphagia, odynophagia, and a lack of appetite caused by the tumor. It is also secondary to the oncological treatment of the basic disease, such as radiotherapy (RT) and chemoradiotherapy (CRT), as a consequence of mucositis with the dry mouth, loss of taste, and dysphagia. The severe dysphagia leads to a definitive total impossibility of eating through the mouth in 20–30% of patients. These patients usually require enteral nutritional support. Feeding tubes are a commonly used nutritional intervention during radiotherapy, most frequently percutaneous gastrostomy tube. Recently, a novel HPV-related type of OPC has been described. Patients with HPV-associated OPC are different from the HPV− ones. Typical HPV− OPC is associated with smoking and alcohol abuse. Patients with HPV+ OPC are younger and healthy (without comorbidities) at diagnosis compared to HPV− ones. Patients with OPC are at high nutritional risk, and therefore, they require nutritional support in order to improve the treatment results and quality of life. Some authors noted the high incidence of critical weight loss (CWL) in patients with HPV-related OPC. Other authors have observed the increased acute toxicities during oncological treatment in HPV+ OPC patients compared to HPV− ones. The aim of this paper is to review and discuss the indications for nutritional support and the kinds of nutrition, including immunonutrition (IN), in HNC, particularly OPC patients, undergoing RT/CRT, considering HPV status.

Highlights

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.license.Head and neck cancer (HNC) includes cancer of the oral cavity, pharynx, larynx, hypopharynx, and paranasal sinus [1]
This study showed that patients continued to lose body weight during and until one year after RT, despite nutrition support and frequent dietary counseling
It is certain and indisputable that nutritional support is necessary in all head and neck cancer (HNC) patients undergoing CRT in order to improve nutritional status and prevent malnutrition caused by the adverse effect of oncological treatment

Summary

Introduction

Head and neck cancer (HNC) includes cancer of the oral cavity, pharynx, larynx, hypopharynx, and paranasal sinus [1]. Some risk factors have been described, including smoking, alcohol abuse, and human papillomavirus (HPV) infection [1,2]. HPV plays a role in the development of a subset of HNCs and, notably, oropharyngeal cancer (OPC) [3]. The role of HPV is not so clear in non-oropharyngeal carcinomas (non-OPCs), but some reports suggest a possible association between HPV infection and nasopharyngeal cancers [3,4,5]. HPV-induced OPC has different biological behavior and a better prognosis compared to non-HPV-induced OPC, and the eighth-edition Tumor-Node-Metastasis (TNM) classification separates these two types [3,6,7]

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